AUGUSTA — Staffing shortages at the state-run Riverview Psychiatric Center in Augusta have led the court master who oversees the state’s mental health system to order a series of changes.

In a Monday filing in Kennebec County Superior Court, Daniel Wathen recommended that Riverview take several specific actions to address chronic staffing shortages and ordered the actions to be carried out in an expedited manner.

Wathen’s order comes after visits to the hospital in recent weeks and calls on the hospital to begin implementing the changes by April 4.

Among Wathen’s recommendations is that the hospital adjust required staffing ratios on a unit-based system as opposed to acuity-based. That essentially means that Riverview must have a certain number of staff on each of the hospital’s four units as opposed to having medical specialists assigned to patients with specific needs as they arise.

The acuity-based system was implemented by the Department of Health and Human Services in the fallout that resulted from the use of correctional officers for dealing with aggressive, high-needs patients. That controversy, among other factors, led the federal government to rescind the hospital’s accreditation, putting $20 million in annual funding at risk.

“There are examples in the hospital of acuity specialists intervening effectively with challenging clients,” wrote Wathen. “Routinely, however, acuity specialists have been assigned to perform as mental health workers in order for the hospital to deal with unit acuity and to maintain the mental health workers/client ratio of 1 to 6 or 1 to 8. … The net result is that the assigned functions of the acuity specialist to prevent challenging behaviors and intervene when necessary are not realized.”

Wathen also suggested that the hospital is relying far too much on overtime and mandated extra shifts, which he said is “not sustainable.” In late 2015, overtime hours were totaling 1,500 to 2,000 per month and mandated shifts were on a steady increase.

Wathen’s order states that as of Jan. 19, Riverview had 51 total staff vacancies, including a nursing shortage that Wathen said is “undoubtedly the most pressing problem.” Of 87 authorized nursing positions, 23 are vacant, he wrote.

“The hospital is actively recruiting and I will continue to monitor staff recruitment and retention and the use of overtime and mandated shifts on a weekly basis,” Wathen wrote. “Because I view the current situation as critical, I shall report promptly to the court if there are any developments that seriously affect the quality of client care and I will promptly make further recommendations regarding the management and operation of Riverview if it becomes necessary.”

Wathen’s position overseeing the hospital was established as part of the 1990 consent decree that resulted from a class action lawsuit against the state for its failure to provide proper treatment to people with mental illness.

The Department of Health and Human Services did not immediately respond to a request for comment.

Court Master's Riverview Progress Report